If left untreated, chronic HCV causes scarring of the liver, known as cirrhosis, which can lead to serious and life-threatening complications, such as liver cancer. In recent years, a highly efficacious treatment for chronic hepatitis C virus (HCV), called direct acting anti-virals or DAAs, has been made available on the NHS. These tablets have very few side effects and the duration of treatment is much shorter than older interferon therapy. Raising awareness about these improvements is vital to help people engage with treatment and reduce longer-term risks to their health.

Progression to cirrhosis is often accelerated in individuals who are also infected with HIV or drink alcohol to excess. The most common route of hepatitis C acquisition is injecting drug use, which disproportionally affects those living in homeless hostels or sleeping on the street. The World Health Organisation (WHO) aims to eliminate hepatitis by 2030, with an emphasis on harm reduction for people who inject drugs and removing barriers to treatment. This is driving the development of community-based services (decentralisation of care) in the quest to find patients ‘invisible’ to care, as well as the education and empowerment of primary care providers.

There is a high prevalence of HCV in the south London boroughs of Lambeth and Southwark. Public Health England (PHE) estimates that over 6,500 people in these boroughs are living with this condition. It is estimated that 58,000 people in London are infected with chronic HCV, however, almost half remain undiagnosed. Furthermore, homeless people are thought to be 50 times more likely to be chronically infected with the hepatitis C virus (HCV), yet only 3% will receive treatment.

Hepatitis C mobile clinic

In order to ensure equity of access, King’s has committed to expanding HCV treatment in the community. We are currently undertaking a homelessness treatment trial called ‘Access to treat in the Community’ (ATTIC), led by Professor Geoffrey Dusheiko, Consultant Hepatologist at King’s College Hospital NHS Foundation Trust using an already licensed drug. ATTIC is a mobile outreach service that will visit homeless hostels in order to improve access to care in a patient population that is currently under-served.

The hepatitis C bus is a mobile clinic room where our team can counsel homeless people about hepatitis C, assess liver problems and treat hepatitis C. They will be supported by peer navigators from The Hepatitis C Trust who will play a key role in patient engagement.

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Geoffrey Dusheiko

Consultant Hepatologist at King's College Hospital

Geoffrey Dusheiko, MD, MB, BCh, is Emeritus Professor of Medicine at the Royal Free Hospital and University College London School of Medicine and Consultant Hepatologist at King's College Hospital London.